This provider's $8.4M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
AI-generated analysis based on Medicare payment data.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2014 | $894.95 | $275.74 | 3.25x | $619.21 | $581.0K | 5.0K | 2.3K |
| 2015 | $823.73 | $223.39 | 3.69x | $600.34 | $647.7K | 5.4K | 2.3K |
| 2016 | $1.0K | $230.30 | 4.40x | $783.05 | $869.7K | 6.4K | 2.7K |
| 2017 | $1.2K | $256.60 | 4.82x | $981.09 | $950.9K | 6.9K | 2.8K |
| 2018 | $1.0K | $235.15 | 4.28x | $771.29 | $998.7K | 7.4K | 2.9K |
| 2019 | $1.0K | $239.56 | 4.25x | $778.19 | $847.1K | 6.4K | 2.6K |
| 2020 | $725.73 | $174.31 | 4.16x | $551.42 | $760.7K | 5.3K | 2.4K |
| 2021 | $1.1K | $254.40 | 4.48x | $885.41 | $999.0K | 6.8K | 2.8K |
| 2022 | $1.2K | $329.73 | 3.62x | $863.86 | $938.4K | 6.5K | 2.8K |
| 2023 | $1.0K | $222.55 | 4.71x | $824.84 | $791.5K | 6.7K | 2.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 5.4K | $3.9M | $730.96 | 1.68x |
| 67028 | Injection of drug into eye | 11.5K | $980.7K | $85.46 | 8.44x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 10.1K | $920.0K | $91.38 | 2.14x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 8.8K | $591.4K | $67.32 | 2.06x |
| 92134 | Diagnostic imaging of retina | 16.8K | $551.3K | $32.86 | 11.32x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.1K | $297.3K | $283.12 | 1.95x |
| J7999 | Compounded drug, not otherwise classified | 3.4K | $221.0K | $65.32 | 1.66x |
| 67042 | Removal of membrane from the retina, pars plana approach | 197 | $191.0K | $969.74 | 5.05x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.5K | $176.7K | $119.38 | 2.09x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 183 | $122.9K | $671.62 | 6.43x |
| J3590 | Unclassified biologics | 682 | $111.7K | $163.73 | 1.86x |
| 92250 | Photography of the retina | 1.5K | $70.2K | $46.90 | 5.53x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 71 | $40.5K | $570.40 | 2.88x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 442 | $38.5K | $87.00 | 6.17x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 77 | $27.3K | $355.13 | 4.03x |
| 76512 | Ultrasound of eye disease, growth, or structure | 366 | $22.4K | $61.17 | 6.89x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 18 | $19.5K | $1.1K | 5.58x |
| 92240 | Examination of eye using an endoscope | 75 | $15.4K | $205.33 | 2.80x |
| 66682 | Repair of iris and lens tissue | 36 | $10.2K | $282.36 | 8.98x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 88 | $7.1K | $81.16 | 1.87x |
This provider submits charges 3.45 times higher than what Medicare actually pays.
A markup ratio of 3.45x means for every $100 Medicare pays, this provider initially charges $345. This is higher than the national average.
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Last Updated: February 2026 (data through 2023, the latest CMS release)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.
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